One health care issue that doesn’t break cleanly along ideological lines is Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Created through regulations by the first Trump Administration in 2019, ICHRAs permit employers to provide pre-tax dollars for employees to purchase individual market health insurance that complies with Affordable Care Act requirements. Take-up has apparently been small, and much is still unknown about their impact.

Recently, efforts have arisen to codify ICHRAs in statute, purportedly because greater certainty would increase take-up. This makes it a good time to check in on ICHRAs and consider next steps.

In this piece, Urban experts explore ICHRAs' virtues and shortcomings and the uncertainty about their effects, now and in the future. The authors argue that additional evidence is needed—and readily available in federal administrative data—to understand ICHRAs' prevalence and effects, and that this inquiry should precede and inform any codification efforts.